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New Hampshire rates for HCPCS 97163

Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $129 · 10th–90th $63–$3160%20%10th90th$129Professionalmedian $95 · 10th–90th $59–$2290%5%10%10th90th$95$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $138.04 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $70.79 / $190.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $97.72 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $93.33 / $204.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $158.49 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $91.20 / $199.53
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $89.13 / $123.03
Well Sense
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70